From Service de Cardiologie B et Hémodynamique, Hôpital
Cardiologique, Lille Cedex, France.
Correspondence to M.E. Bertrand, MD, Service de Cardiologie B, Hôpital Cardiologique, Boulevard du Professeur J Leclercq, 59037 Lille Cedex, France. E-mail bertrandme{at}aol.com
Background—Limited angioscopic
information is available on the natural history of infarct-related
plaque after myocardial infarction (MI), in particular the effect
of thrombolysis.
Methods and Results—We studied with angioscopy the
morphological characteristics of the infarct-related lesion in 56
patients between 24 hours and 4 weeks after MI. Forty of these patients
were initially treated with a thrombolytic agent. Most
lesions were complex (complex+ulcerated shape=54%). The predominant
color of the plaque was yellow in 79% of cases; only 6% were
uniformly white. Angioscopically visible thrombus was found in 77% of
cases. Despite angioscopic evidence of instability, only 7% of the
patients had post-MI angina. During the 1-month time window since the
occurrence of MI, there was no significant difference in the
angioscopic appearance of the plaque except for a slight increase in
uniformly white plaques (P=.07). The use of a
thrombolytic agent at the onset of MI was associated
with a reduction in thrombus size and less protruding thrombi
(P=.02) but not with a decreased frequency of plaque
containing thrombi. Furthermore, a trend for more frequently ulcerated
plaques (45% versus 16%, P=.06) was associated with
the use of a thrombolytic agent.
Conclusions—These results suggest that healing of the
infarct-related lesion requires more than 1 month and that an
"unstable" yellow plaque with adherent thrombus is common during
that period. This finding may partly explain the unique behavior of
recent infarct-related lesions, which are more prone to occlude than
other lesions.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Coronary Angioscopic Findings in the Infarct-Related Vessel Within 1 Month of Acute Myocardial Infarction
Natural History and the Effect of Thrombolysis
Key Words: myocardial infarction • thrombolysis • angioplasty
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